Surgical clip applier with integrated cutter

ABSTRACT

A surgical clip applier is provided including a housing, at least one handle pivotably connected to the housing, an outer support channel extending distally from the housing, a drive channel sliadably disposed within the outer support channel, a jaw assembly including a first and second pair of jaws extending from an end of the outer support channel in a parallel configuration, and an integrated cutting mechanism disposed within a gap defined between the first and second pair of jaws. The jaw assembly is capable of effectuating formation of a pair of clips disposed within a respective first and second pair of jaws in response to movement of the at least one handle and the cutting mechanism is independently operable of the at least one handle. At least one jaw member of each of the pair or jaws includes a curved distal end. A method of operating same is also provided.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority to U.S. Provisional Patent Application No. 62/108,582 filed Jan. 28, 2015, the entire disclosure of which is incorporated by reference herein.

BACKGROUND

1. Technical Field

The present application relates to surgical instruments, and more particularly, to surgical clip appliers capable of applying one or more clips to body tissues and vessels simultaneously and thereafter, transecting body tissues and/or vessels during surgical procedures.

2. Discussion of Related Art

Surgical clip appliers are known in the art and have increased in popularity among surgeons by offering an alternative to conventional suturing of body tissues and vessels. One example of such an instrument is disclosed in U.S. Pat. No. 3,735,762 to Bryan et al. Although capable of applying multiple clips simultaneously, and thereafter, transecting tissue, instruments such as the one disclosed in the Bryan et al. patent perform the steps of ligating and transecting the tissue in a single motion (i.e., in one continuous motion). This continuous motion makes it difficult for the surgeon to inspect the quality of ligation before transecting the tissue.

Although instruments such as these reduce the complexity and overall time required to complete the operation, there remains a need for a clip applier having the ability to apply multiple clips simultaneously, while being able to transect tissue independently of clip application.

SUMMARY

The present application relates to surgical clip appliers capable of applying one or more clips to body tissues and vessels simultaneously and thereafter, transecting body tissues and/or vessels during surgical procedures and their methods of use.

According to an aspect of the present disclosure, a surgical clip applier is provided including a housing, at least one handle pivotably connected to the housing, an outer support channel extending distally from the housing, a drive channel slidably disposed within the outer support channel, a jaw assembly including a first and second pair of jaws extending from an end of the outer support channel in a parallel configuration, and a cutting mechanism disposed within a gap defined between the first and second pair of jaws. The drive channel is in mechanical communication with the at least one handle. The cutting mechanism extends from an end of the outer support channel and includes a pair of elongate members capable of movement relative to each other. The cutting mechanism is capable of operation independent of the at least one handle. Each of the first and second pair of jaws is configured to receive a respective clip therein. The jaw assembly is operable to effect formation of each respective clip in response to movement of the at least one handle and the drive channel and at least one jaw member of each of the pair of jaws includes a curved distal end extending towards the opposite one of the at least one jaw member.

The clip applier may further include a biasing element disposed within the drive channel. The biasing element may be in operable communication with the at least one handle such that the at least one handle is biased towards a first, open position.

The clip applier may further include a clip loaded into each jaw of the first and second pairs of jaws. The clip may include first and second arms extending distally from a crown. The arms may extend distally in a parallel configuration and the first arm may include a transverse extension on a distal end thereof extending towards the second arm.

The first arm of the clip may include a cutout adapted to receive a tapered distal end of the second arm when the clip is fully formed.

The clip applier may further include a trigger lock capable of retaining the at least one handle in a second position wherein the jaw assembly is in an approximated position.

The trigger lock may be manually releasable.

The clip applier may further include a shuttle slidably disposed within the outer support channel. The shuttle may be in mechanical cooperation with the cutting mechanism.

The shuttle may include an actuating pin disposed on opposing sides of a proximal end thereof.

The shuttle may further include a V-shaped notch defined through opposing sides of a distal end thereof. The V-shaped notch may be configured to engage the pair of elongate members of the cutting mechanism.

A distal end of each of the pair of elongate members of the cutting mechanism may include a sharpened edge capable of transecting tissue. The sharpened edges may be in juxtaposed relation to one another.

Advancement of the shuttle may cause the V-shaped notch to engage a proximal end of each of the pair of elongate members, thereby causing the distal end of each of the pair of elongate members to move from a first, open, position, to a second, approximated, position.

According to another aspect of the present disclosure, a method of ligating and transecting tissue is also provided, including selecting a surgical clip applier including a housing, at least one handle pivotably connected to the housing, an outer support channel extending distally from the housing, a drive channel slidably disposed within the outer support channel, a jaw assembly including a first and second pair of jaws extending from an end of the outer support channel in a parallel configuration, and a cutting mechanism disposed within a gap defined between the first and second pair of jaws. The drive channel is in mechanical communication with the at least one handle. The cutting mechanism extends from an end of the outer support channel and includes a pair of elongate members capable of movement relative to each other. The cutting mechanism is capable of operation independent of the at least one handle. Each of the first and second pair of jaws is configured to receive a respective clip therein. The jaw assembly is operable to effect formation of each respective clip in response to movement of the at least one handle and the drive channel and at least one jaw member of each of the pair of jaws includes a curved distal end extending towards the opposite one of the at least one jaw member.

The method further includes loading a pair of clips within a respective first and second pair of jaws, advancing the first and second pair of jaws of the clip applier within an incision of a patient, disposing target tissue into the jaw assembly and into the cutting mechanism, actuating the at least one handle to advance the drive channel, and actuating the cutting mechanism independent of the at least one handle, thereby transecting the target tissue. Advancing the drive channel causes the first and second pairs of jaws to move from an open position to an approximated position, thereby effectuating formation of the pair of clips.

The actuation of the cutting mechanism may further include advancing a shuttle slidably disposed within the outer support housing. The shuttle may include a V-shaped cutout defined in opposing sides of the shuttle dimensioned to move the elongate members of the cutting mechanism from a first, open position, to a second, approximated position, thereby transecting the target tissue.

The method may further include releasing a trigger lock to return the at least one handle to a first, open position.

Although the above aspects and embodiments are described separately for convenience and clarity, it is contemplated that the above aspects and embodiments may be combined without departing from the scope of the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The present clip applier will be more fully appreciated as the same becomes better understood from the following detailed description when considered in connection with the following drawings, in which:

FIG. 1 is a top, plan view, of a surgical clip applier according to an embodiment of the present disclosure;

FIG. 2 is an enlarged top, plan view, of a handle assembly of the surgical clip applier of FIG. 1;

FIG. 3 is a top, plan view, of the surgical clip applier of FIG. 1, showing a return spring thereof;

FIG. 4 is an enlarged top, plan view, of the handle assembly of FIG. 2, showing the surgical clip applier of FIG. 1 in an approximated position;

FIG. 5 is a front, perspective view, of a distal end of the surgical clip applier of FIG. 1;

FIG. 6 is a front, perspective view, of a single jaw member and a surgical clip of the surgical clip applier of FIG. 1;

FIG. 7 is a front, perspective view, of the distal end of the surgical clip applier of FIG. 1, shown disposed on a body vessel;

FIG. 8 is a top, plan view, of the surgical clip applier of FIG. 1 showing the jaw members and an integrated cutting mechanism in an open position;

FIG. 9 is a top, plan view, of the surgical clip applier of FIG. 1, shown with the jaw members in an approximated position;

FIG. 10 is a top, plan view, of the surgical clip applier of FIG. 1 showing a shuttle in an advanced position;

FIG. 11 is a top, plan view, of the surgical clip applier as shown in FIG. 9, showing the cutting mechanism in an approximated position and the jaw members in an open position; and

FIG. 12 is a rear, perspective view, of a surgical clip according to an embodiment of the present disclosure.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of surgical clip appliers in accordance with the present disclosure will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical structural elements. As shown in the drawings and described throughout the following description, as is traditional when referring to relative positioning on a surgical instrument, the term “proximal” refers to the end of the apparatus which is closer to the user and the term “distal” refers to the end of the apparatus which is further away from the user.

Referring now to FIG. 1, a surgical clip applier in accordance with an embodiment of the present disclosure is generally designated as 100. It is contemplated that any of the components of surgical clip applier 100 may be formed from any suitable biocompatible material such as stainless steel, titanium, or the like. Surgical clip applier 100 generally includes a handle assembly 102 including a housing 104 having upper housing half 104 a and lower housing half 104 b. Handle assembly 102 further includes a pair of handles 106 pivotably secured to housing 104 and extending outwardly therefrom. An outer support channel 108 is fixedly secured to housing 104 and extends distally therefrom. Housing halves 104 a and 104 b may be joined through one or more screws, rivets, or the like, or through the use of glues or other adhesives.

Continuing with FIG. 1, handles 106 are pivotably secured to housing 104 by handle pivot pins (not shown) extending between upper and lower housing halves 104 a, 104 b through respective apertures 106 a formed in handles 106. Handle pivot pins may be any suitable fastener, such as a roll pin, rivet, screw, or the like. Handle assembly 102 includes a link member 122 pivotally connected, by means of a retaining pin (not shown), to each handle 106 at a pivot point 106 b formed in a lug disposed on a respective handle 106. Although generally shown as being formed in a lug, it is contemplated that pivot point 106 b may be integrally formed through inner and outer surfaces of a respective handle 106. A distal end of each link member 122 is pivotally connected to a pivot point 142 formed in a drive channel 140 via a drive pin (not shown). The drive pin and retaining pins may be any suitable pin, such as a roll pin, rivet, screw, or the like.

A return spring 144 (FIG. 3) is disposed about pivot point 142 within drive channel 140 and includes spring arms 144 a extending proximally therefrom. Spring arms 144 a are compressed by handles 106, as handles 106 are squeezed, and provide a biasing force in a direction maintaining handles 106 in an open position.

Handle assembly 102 further includes trigger lock 146 (FIG. 4). Trigger lock 146 includes upper and lower ends and defines a longitudinal axis extending therebetween. Trigger lock 146 is rotatably secured to a handle 106 at an upper end and includes a locking arm 146 a on the lower end extending in a direction normal to the longitudinal axis. Locking arm 146 a engages the opposite handle 106 when handles 106 are in an approximated position (FIG. 2), thereby prohibiting return spring 144 from returning handles 106 to an open position. Trigger lock 146 is manually released, such that handles 106 may only return to an open position after locking arm 146 a is manipulated to release handle 106.

With reference to FIGS. 1 and 8, outer support channel 108 is generally shown as having a substantially quadrilateral cross section; however, it is contemplated that outer support channel 108 may have any suitable shape, such as circular, oval, or the like. Drive channel 140 is slidably supported within a lumen 108 a (FIG. 8) defined through proximal and distal ends of outer support channel 108. Although generally shown as having a cross section complimentary to that of outer support channel 108, it is contemplated that drive channel 140 may have any suitable shape, such as rectangular, square, circular, or the like. A distal end of drive channel 140 is substantially box shaped or rectangular for receiving jaw assembly 150 and for actuating jaw assembly 150 upon translation of drive channel 140 relative to jaw assembly 150.

Referring now to FIGS. 5 and 6, an illustration of jaw assembly 150 is shown. Jaw assembly 150 includes two pairs of jaws 152, 153 mounted on or at a distal end of outer support channel 108 and actuatable by handles 106, as will be discussed in further detail herein. As shown in FIG. 5, each one of the pair of jaws 152, 153 is arranged in a side-by-side configuration, separated by a channel or gap 154. Jaws 152, 153 are formed from any suitable biocompatible material such as stainless steel, titanium, or the like. Jaws 152, 153 are mounted within a distal end of outer support channel 108 via any suitable means capable of retaining jaws 152, 153 at a position longitudinally stationary relative to outer support channel 108, such as screws, rivets, or the like.

In the interest of brevity, jaw 152 is similar to jaw 153 and thus only the details of jaw 152 will be described in further detail herein. As shown in FIG. 6, the distal end of jaw 152 includes a first jaw portion 152 a having a straight configuration and a second jaw portion 152 b having a curved configuration such that the distal end of second jaw portion 152 b curves towards first jaw portion 152 a. The curved distal end of second jaw portion 152 b extends past or across first jaw portion 152 a such that first jaw portion 152 a nests within second jaw portion 152 b when jaw 152 is in an approximated position. The curved distal end of second jaw portion 152 b permits easier access to the target tissue by encouraging the tissue to be scooped into the jaw assembly 150, facilitates retention of a surgical clip 160 within respective jaw 152, 153, and facilitates proper formation of surgical clip 160. Jaw 152 defines a channel 152 c between first and second jaw portions 152 a, 152 b for manually receiving a surgical clip 160 therein.

Continuing with FIG. 6, during actuation of handles 106 of clip applier 100, the distal end of drive channel 140 is distally advanced and acts against a tapered portion 156 of each of the pair of jaws 152, 153, thereby causing each of the pair of jaws 152, 153 to transition from an open position to an approximated position, which in turn, forms the surgical clip 160 disposed between the respective first and second jaw portions thereof.

With reference to FIG. 9, an illustration of an integrated cutting mechanism 170 of the clip applier 100 is shown. Integrated cutting mechanism 170 is disposed between the pair of jaws 152, 153, and includes a pair of elongate members 170 a, hingedly connected about a hinge pin (not shown). The hinge pin is disposed within a bore 170 b defined through a center region of each of the pair of elongate members 170 a and is retained within a through-hole 108 b defined through inner and outer side surfaces of outer support channel 108. The hinge pin may be any suitable pin, such as a roll pin, rivet, screw, or the like. As shown in FIG. 9, the pair of elongate members 170 a are oriented substantially in an “x” configuration, such that an application of opposing forces on the proximal end of each of the pair of elongate members 170 a causes the pair of elongate members 170 a to rotate about the hinge pin, thereby causing the distal end of each of the pair of elongate members 170 a to move from an open position to an approximated position (i.e., in a scissoring manner). The inner edges of the distal end of the pair of elongate members 170 a may include a sharpened edge 170 c to facilitate transecting or cutting of tissue disposed therebetween. It is contemplated that sharpened edge 170 c may be disposed on each of the pair of elongate members 170 a in juxtaposed relation to each other.

Referring now to FIG. 10, an illustration of a shuttle 174 of clip applier 100 is shown. Shuttle 174 is disposed within outer support channel 108 and is dimensioned to be slidably supported therein, such that shuttle 174 may be operated independent of any actuation of handles 106. A proximal end of shuttle 174 includes actuating pins 174 a disposed on opposing sides thereof. Actuating pins 174 a may be integral to shuttle 174 or may be any suitable pin retained within a through-bore (not shown) defined within shuttle 174. Alternatively, a single actuating pin may extend completely through shuttle 174 and project from opposed sides thereof. Actuating pins 174 a extend through slots 110 defined through opposing sides of outer support channel 108, thereby enabling a clinician to grasp and advance shuttle 174 within outer support channel 108. A distal end of shuttle 174 includes a V-shaped cutout or notch 174 b defined through opposing sides of shuttle 174. As seen in FIG. 11, V-shaped cutout 174 b is configured to impart a force upon the proximal end of the pair of elongate members 170 a of the integrated cutting mechanism 170 as shuttle 174 is advanced, thereby causing the elongate members 170 a to move from an open position, to an approximated position.

An embodiment of a surgical clip 160, according to the present disclosure, is illustrated in FIG. 12. Surgical clip 160 includes parallel first and second arms 160 a, 160 b extending in a common direction from a crown 160 c, thereby forming a generally U-shaped configuration. The free end of second arm 160 b extends further than opposing first arm 160 a and includes a transverse extension 160 d, extending in a direction towards first arm 160 a, such that the target tissue or vessel “V” may be secured therein before the surgical clip 160 is fully formed, thereby reducing the possibility that the target tissue or vessel “V” will slip out of the surgical clip 160. A cutout or recess 160 e is defined within the intersection of second arm 160 b and transverse extension 160 d, and is configured to receive a tapered free end 160 f of first arm 160 a when surgical clip 160 is fully formed, increasing the amount of force required for the target tissue or vessel “V” to be pulled out of the surgical clip 160 (i.e., decreasing the probability that the target tissue or vessel “V” may be pulled out of the surgical clip 160). Surgical clip 160 is dimensioned to be received within channel 152 c of jaws 152, 153 such that when surgical clip 160 is advanced within channel 152 c, transverse extension 160 d abuts the curved distal end of second jaw portion 152 b, thereby preventing surgical clip 160 from further advancing. Surgical clip 160 may be formed from any suitable biocompatible material, such as stainless steel, titanium, or the like.

With reference to FIGS. 1-12, the operation of clip applier 100 is provided. Prior to any initial squeezing of handles 106 of clip applier 100, a pair of clips 160 are loaded into the jaw assembly 150 by advancing each clip within a respective channel 152 c of first and second jaws 152, 153 until transverse extension 160 d of surgical clip 160 abuts the curved distal end of respective second jaw portion 152 b (FIG. 6) (i.e., until transverse extension 160 d of surgical clip 160 is disposed proximal to the curved distal end of second jaw portion 152 b). Clip applier 100 is then advanced within an incision of a patient, and using the curved distal end of second jaw portion 152 b, the clinician may scoop the target tissue or vessel “V” within the jaws 152, 153. The curved distal end of each second jaw portion 152 b inhibits the target tissue or vessel “V” from becoming dislodged from the jaws 152, 153 of the clip applier 100.

As handles 106 are squeezed an initial amount, link members 122 push drive pin 142 distally (FIG. 3). As drive pin 142 is pushed distally, drive channel 140 is also translated distally within outer support channel 108. As handles 106 are squeezed further, drive channel 140 advances distally such that the distal end of drive channel 140 comes into contact with tapered portion 156 of jaws 152, 153. With continued squeezing of handles 106, the distal end of drive channel 140 cams the tapered portion 156 of jaws 152, 153, causing jaws 152, 153 to move from an open position to an approximated position (FIG. 5). Manipulating jaws 152, 153 from an open position to an approximated position forms surgical clip 160 about the target tissue or vessel “V” such that the tapered distal end 160 f of first arm 160 a nests within cutout 160 e of second arm 160 b, thereby inhibiting the target tissue or vessel “V” from becoming dislodged from the surgical clip 160 (FIG. 8).

Once handles 106 are fully squeezed such that the surgical clip 160 is fully formed, locking arm 146 a of trigger lock 146 may be engaged, thereby preventing handles 106 from returning to the open position (FIG. 4). Once trigger lock 146 is engaged, the clinician may inspect each surgical clip 160 to ensure proper ligation. Thereafter, if the surgical clips 160 are adequately formed, actuating pin 174 a is advanced distally along outer support channel 108 (FIG. 10). As actuating pin 174 a is advanced, shuttle 174 is advanced causing V-shaped cutout 174 b to engage the proximal end of the pair of elongate members 170 a of the integrated cutting mechanism 170 (FIG. 9). As actuating pin 174 a is further advanced, the pair of elongate members 170 a move from an open position to an approximated position (i.e., in a scissoring action), where the sharpened edges 170 b transect or cut the target tissue or vessel “V” (FIG. 11). After transecting the target tissue or vessel “V”, actuating pin 174 a is retracted proximally to return the integrated cutting mechanism 170 to the open position. Thereafter, the trigger lock 146 is manually released, thereby allowing return spring 144 to return handles 106 to the open position, releasing the target tissue or vessel “V” from jaws 152.

After handles 106 are returned to the initial or original position, clip applier 100 is ready to apply additional surgical clips 160 to tissue or vessels in the manner described above.

It should be understood that the foregoing description is only illustrative of the present disclosure. Various alternatives and modifications can be devised by those skilled in the art without departing from the disclosure. Accordingly, the present disclosure is intended to embrace all such alternatives, modifications and variances. The embodiments described with reference to the attached drawing figures are presented only to demonstrate certain examples of the disclosure. Other elements, steps, methods and techniques that are insubstantially different from those described above and/or in the appended claims are also intended to be within the scope of the disclosure. 

What is claimed is:
 1. A surgical clip applier, comprising: a housing; at least one handle pivotably connected to the housing; an outer support channel extending distally from the housing; a drive channel slidably disposed within the outer support channel, the drive channel in mechanical communication with the at least one handle; a jaw assembly including a first and second pair of jaws extending from an end of the outer support channel, the first and second pair of jaws disposed in a parallel configuration, each of the first and second pair of jaws configured to receive a respective clip therein, wherein the jaw assembly is operable to effect formation of each respective clip in response to movement of the at least one handle and the drive channel, wherein at least one jaw member of each of the pair of jaws includes a curved distal end, the curved distal end extending towards the opposite one of the at least one jaw member, the curved distal end configured to retain tissue therein; and a cutting mechanism disposed within a gap defined between the first and second pair of jaws, the cutting mechanism extending from an end of the outer support channel and including a pair of elongate members capable of movement relative to each other, wherein the cutting mechanism is capable of operation independent of the at least one handle.
 2. The clip applier according to claim 1, further including a biasing element disposed within the drive channel, the biasing element in operable communication with the at least one handle such that the at least one handle is biased towards a first, open position.
 3. The clip applier according to claim 1, further comprising a clip loaded into each jaw of the first and second pairs of jaws, wherein the clip includes first and second arms extending distally from a crown, the arms extending distally in a parallel configuration, wherein the first arm includes a transverse extension on a distal end thereof extending towards the second arm, the transverse extension configured to secure tissue therein before formation of the clip.
 4. The clip applier according to claim 3, wherein the first arm of the clip includes a cutout adapted to receive a tapered distal end of the second arm when the clip is fully formed, thereby decreasing the probability that the tissue may be pulled out of the clip.
 5. The clip applier according to claim 1, further including a trigger lock capable of retaining the at least one handle in a second position wherein the jaw assembly is in an approximated position.
 6. The clip applier according to claim 5, wherein the trigger lock is manually releasable.
 7. The clip applier according to claim 1, further including a shuttle slidably disposed within the outer support channel, the shuttle being in mechanical cooperation with the cutting mechanism.
 8. The clip applier according to claim 7, wherein the shuttle includes an actuating pin disposed on opposing sides of a proximal end thereof.
 9. The clip applier according to claim 8, wherein the shuttle further includes a V-shaped notch defined through opposing sides of a distal end thereof, the V-shaped notch configured to engage the pair of elongate members of the cutting mechanism.
 10. The clip applier according to claim 1, wherein a distal end of each of the pair of elongate members of the cutting mechanism includes a sharpened edge capable of transecting tissue, wherein the sharpened edges are in juxtaposed relation to one another.
 11. The clip applier according to claim 8, wherein advancement of the shuttle causes the V-shaped notch to engage a proximal end of each of the pair of elongate members, thereby causing the distal end of each of the pair of elongate members to move from a first, open, position, to a second, approximated, position.
 12. A method of ligating and transecting tissue, comprising the steps of: selecting a surgical clip applier including: a housing; at least one handle pivotably connected to the housing; an outer support channel extending distally from the housing; a drive channel slidably disposed within the outer support channel, the drive channel in mechanical communication with the at least one handle; a jaw assembly including a first and second pair of jaws extending from an end of the outer support channel, the first and second pair of jaws disposed in a parallel configuration, each of the first and second pair of jaws configured to receive a respective clip therein, wherein the jaw assembly is operable to effect formation of each respective clip in response to movement of the at least one handle and the drive channel, wherein at least one jaw member of each of the pair of jaws includes a curved distal end, the curved distal end extending towards the opposite one of the at least one jaw member such that tissue is retained therein; and a cutting mechanism disposed within a gap defined between the first and second pair of jaws, the cutting mechanism extending from an end of the outer support channel and including a pair of elongate members capable of movement relative to each other, wherein the cutting mechanism is capable of operation independent of the at least one handle; loading a pair of clips within a respective first and second pair of jaws; advancing first and second pair of jaws of the clip applier within an incision of a patient; disposing target tissue into the jaw assembly and into the cutting mechanism; actuating the at least one handle to advance the drive channel, wherein advancing the drive channel causes the first and second pairs of jaws to move from an open position to an approximated position, thereby effectuating formation of the pair of clips; and actuating the cutting mechanism independent of the at least one handle, thereby transecting the target tissue.
 13. The method of claim 12, wherein actuating the cutting mechanism further includes advancing a shuttle slidably disposed within the outer support channel, the shuttle including a v-shaped cutout defined in opposing sides of the shuttle dimensioned to move the elongate members of the cutting mechanism from a first, open position, to a second, approximated position, thereby transecting the target tissue.
 14. The method of claim 12, further including releasing a trigger lock to return the at least one handle to a first, open position. 